Epidemiological Characteristics of Clinically- Confirmed Cases of Chikungunya in Teculutan, Guatemala

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1 University of Rhode Island Senior Honors Projects Honors Program at the University of Rhode Island 2016 Epidemiological Characteristics of Clinically- Confirmed Cases of Chikungunya in Teculutan, Guatemala Annaly Aldana University of Rhode Island, Follow this and additional works at: Part of the Environmental Public Health Commons, Epidemiology Commons, International Public Health Commons, and the Virus Diseases Commons Recommended Citation Aldana, Annaly, "Epidemiological Characteristics of Clinically-Confirmed Cases of Chikungunya in Teculutan, Guatemala" (2016). Senior Honors Projects. Paper This Article is brought to you for free and open access by the Honors Program at the University of Rhode Island at It has been accepted for inclusion in Senior Honors Projects by an authorized administrator of For more information, please contact

2 Chikungunya and Zikaat the Front Door The very first time I heard of chikungunya virus was when my grandmother contracted it. My families from both parents live in Guatemala. It was March of 2015 when my father received a call from my aunt, crying and telling him my grandmother had fainted. She is one of the chikungunya cases that present severe symptoms of abdominal and joint pain, and high fevers. Due to the severity of the pain in her joints, she is now unable to walk or sit straight; chikungunya means to be contorted. From there, many more family members contracted the virus, though their symptoms were not as severe as my grandmother s. I did worry about them, but only a limited amount, since I knew they would recover. I certainly did not consider chikungunya a threat to my health. That is, until I traveled to Guatemala for winter vacation. I was traveling to our home town of Teculutan, a municipality in the Guatemalan department of Zacapa. Before departing, my family warned my parents of the recent epidemic of the chikungunya virus. During the months of October, vember and December, there had been an increase in the cases of CHKV, and many of my family members were just recovering from this virus. Therefore, I bought several bottles of insect repellent, and made sure I took long-sleeve shirts with me, and light long pants to wear during the day. The chikungunya virus is transmitted by a mosquito known as the Yellow fever mosquito, or Aedes aegypti by its species name. Such mosquito only bites during the day. So, upon my arrival, I felt prepared against the female mosquito and its bites, with my repellents and long-sleeve shirts; however, the weather made it impossible. Temperatures were in the high F, and all I wanted to do was run to the nearest river and jump in the cold water. The heat irritated my skin and the repellent only made this worse so I ultimately decided to skip it. Despite my efforts, I got bitten by mosquitoes several times during the day. I felt vulnerable. t only could I contract chikungunya, but by then the pandemic of Zika was sweeping through Guatemala. While I was there, my cousin contracted Zika. At first, I couldn t understand why this virus was spreading so fast. I came up with the idea of conducting my senior honors project on chikungunya virus, and, since they are transmitted by the same mosquito, indirectly also the Zika virus. I contacted the coordinator of the local health center, which is a free clinic open to the public, and ran by the Guatemalan Department of Health. For several days, I worked with the epidemiological sheets of diagnosed CHKV cases, with aims of discovering any trend on the symptoms, age, location, gender, and occupation. Also, I interviewed the doctor and two nurses to learn about their experiences and perspectives of dealing with the chikungunya virus, and more recently the Zika virus. Interestingly enough, the doctor and nurses shared what they thought was needed in order to control and manage the high incidences of these viruses, educating the community. The doctor mentioned that it is inevitable to avoid the environmental conditions that make it ideal for the mosquito to breed faster, but there are many factors within the cultural lifestyles that could help control the epidemic of vector-borne viruses such as dengue, chikungunya, and Zika.

3 In order to understand how a virus is transmitted in municipalities like Teculutan, it is crucial to consider the cultural lifestyles. In Teculutan, like in many other municipalities across Guatemala, the majority of leisure time is spent outdoors. For the most part, the area where Zacapa is located is the warmest all year around, except for cooler weather during the last three months of the year. Due to the hot weather, families typically have an outdoor area to rest, and spend time with family. In many instances, it isn t a choice, but a necessity. Teculutan is a relatively poor community, where many homes lack windows, and a roof in the kitchen and resting areas. Grandparent s home resting areas. Also, in the lines of discussing kitchen areas, most families own an outdoor sink to wash the dishes, clothing, and it is the main water container at home. These outdoor sinks, also called pilas are one of the most common breeding habitats for mosquitoes. It is water that is stagnant, it is not flowing, and it is not cleaned often. The doctor of the clinic mentioned that, through a survey conducted in town with purposes of assessing and tracking mosquito breeding habits, families were asked about their knowledge on mosquito egg and larvae; many of them did not believe a larva would later turn into a mosquito. After analyzing the data collected through exploratory data visualization, I compared the demographics of suspected and confirmed CHKV cases to the population of Teculutan as a whole. I found that women in the household are particularly at risk for chikungunya in Teculutan. I also found that there were hot spots of mosquito abundance in poor residential areas.

4 These results combined with information obtained from the interviews conducted all pointed to a critical need to assess the average citizens knowledge, attitudes and preventive practices toward mosquito-borne diseases and mosquito prevention. As part of my honors project, I developed a Knowledge, Attitudes, and Practices Survey (KAP), which is a tool for assessing the general and specific knowledge on the mosquito, the virus, and the diseases of chikungunya and Zika. I provided this tool to the clinic to use moving forward as it continues on the front line of these epidemics. Knowledge KAP Survey CHKV and Teculutan Symptoms YES NO 1. Is fever a symptom of CHKV? 2. Is arthritis (joint pain) a symptom of CHKV? 3. Are allergies a symptom of CHKV? 4. Is headache a symptom of CHKV? 5. Is back pain a symptom of CHKV? 6. Is nausea a symptom of CHKV? 7. Is mucosal hemorrhage a symptom of CHKV? 8. Is vomit a symptom of CHKV? 9. Is rash a symptom of CHKV? Transmission 1. Is CHKV in the air? 2. Is CHKV in the water? 3. Do mosquitoes transmit CHKV? 4. Can CHKV be transmitted from one person to another? 5. Can CHKV be transmitted by blood transfusion? 6. Can CHKV be transmitted by sexual intercourse? Mosquito 1. Where do mosquitoes come from? Egg in the water Egg outside the water

5 Egg in trees I Don t Know 2. When are the CHKV mosquitoes likely to bite/feed? Night time Day time All day 3. Do mosquitoes breed in stagnant water? 4. All types of mosquitoes transmit CHKV 5. Aedes aegypti likes to linger indoors 6. Insect repellents reduce mosquito bites and prevent CHKV? 7. Covering water containers reduces mosquitoes? 8. Does removal of stagnant water prevent mosquito breeding?

6 9. Insecticide spray reduces mosquito and prevents CHKV 10. Cleaning backyards can prevent mosquito breeding and prevent CHKV 11. Covering outdoor sinks can reduce mosquito breeding and prevent CHKV 12. Using window screens during the day can prevent mosquitoes indoors 13. Pouring chemicals in stagnant water can kill mosquito larvae? 14. Pouring chemicals in outdoor sinks is safe Knowledge of Management 1. Would you take acetaminophen for CHKV?

7 2. Would you drink plenty of fluids for CHKV? 3. Would you get plenty of rest for CHKV? 4. Would you seek medical attention for CHKV? 5. Is there treatment/cure for CHKV? How did you (hear, learn, find out) about CHKV? - TV/Radio - School - Work - Health providers - Family/friend - Newspaper - Social media - Neighbors - Child - Publicity Attitudes 1. CHKV is a punishment from God

8 2. CHKV is a serious illness? 3. You are susceptible to CHKV 4. CHKV can be prevented 5. CHKV is a deadly illness 6. Are you worried about you or your family of getting CHKV? 7. If you had CHKV before, you can/will get it again

9 8. If sick, you would go to the local public clinic 9. CHKV is a community problem 10. CHKV is an environmental problem 11. Everyone is susceptible of getting CHKV 12. The government is doing everything to help control CHKV outbreak Practices Preventing mosquito-human contact YESNO

10 1. Use insecticide sprays to reduce mosquitoes 2. Seek professional pest control to reduce mosquitoes 3. Use window screens to reduce mosquitoes 4. Use bed nets to reduce mosquitoes 5. Use ventilators to reduce mosquitoes 6. Cover standing water containers to reduce mosquitoes 7. Cover outdoor sink tanks to reduce mosquitoes 8. Clean backyards to reduce mosquitoes 9. Dispose garbage to reduce mosquitoes 10. Use mosquito eating fish to reduce mosquitoes 11. Close doors to prevent mosquitoes indoors 12. Use long-sleeve shirts and long pants to prevent mosquito bite 13. Use disc insect repellent at night time to reduce mosquito indoors 14. Use body repellent when going outdoors to reduce mosquito bite 15. Does nothing to reduce mosquitoes Eliminating mosquito breeding sites 1. Cover water contains in the home YES NO Frequency of cleaning water filled containers around the house - Always - Often - Sometimes - Rarely - Never Frequency of emptying and brushing outdoor sink water tank - Always - Often - Sometimes - Rarely - Never

11 Honors Project Poster

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